Abstract: Devices and methods for performing a procedure within a sacrum are disclosed herein. In one variation, a method includes imaging a spine with a fluoroscopy device to provide a view of the sacrum. An anatomical landmark is identified based on the imaging, and a breach zone is defined based on the imaging. The anatomical landmark is used to identify an entry point and guide a medical device in a medial-to-lateral approach into a sacral ala region of the sacrum to perform a medical procedure within the sacral ala. In some embodiments, the anatomical landmark can be, for example, a pedicle, and in some embodiments, the anatomical landmark can be, for example, a V notch. In some embodiments, an entry point is identified using two anatomical landmarks. For example, the anatomical landmarks can be an S1 foramen of the side being accessed and a sacroiliac joint.